Provider Demographics
NPI:1295254290
Name:RIVERA VEGA, NELITZA IVEMARIS
Entity type:Individual
Prefix:
First Name:NELITZA
Middle Name:IVEMARIS
Last Name:RIVERA VEGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 CALLE BALTAZAR MENDOZA
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00736
Mailing Address - Country:US
Mailing Address - Phone:787-900-6640
Mailing Address - Fax:
Practice Address - Street 1:3190 N MCMULLEN BOOTH RD STE 200
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-2013
Practice Address - Country:US
Practice Address - Phone:813-855-2900
Practice Address - Fax:813-855-2990
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-12
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1679002084N0400X
TXBP10067382084N0400X
NY3219022084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty